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Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica

INTRODUCTION: In giant cell arteritis (GCA) headache of new onset due to inflammatory involvement of the temporal artery (TA) represents a diagnostic criterion. A widespread headache (WH) with scalp tenderness due to cranial arteritis can represent another manifestation of GCA. MATERIAL AND METHODS:...

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Autor principal: Manzo, Ciro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149570/
https://www.ncbi.nlm.nih.gov/pubmed/27994267
http://dx.doi.org/10.5114/reum.2016.63663
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author Manzo, Ciro
author_facet Manzo, Ciro
author_sort Manzo, Ciro
collection PubMed
description INTRODUCTION: In giant cell arteritis (GCA) headache of new onset due to inflammatory involvement of the temporal artery (TA) represents a diagnostic criterion. A widespread headache (WH) with scalp tenderness due to cranial arteritis can represent another manifestation of GCA. MATERIAL AND METHODS: In 225 elderly patients with polymyalgia rheumatica (PMR) followed in our rheumatologic outpatient clinic from 2004 until June 2016, the frequency of WH as the first clinical manifestation of GCA was evaluated. RESULTS: Among 26 patients with GCA+PMR (11.6% of total), 5 (23.07%) had WH as first clinical manifestation of GCA without TA. In all these patients TA colour duplex sonography (CDS) and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) with total body contrast-enhanced CT was consistent with the diagnosis of arteritis. TA biopsy was not performed. High doses of prednisone (1 mg/kg/day) led to the immediate and total disappearance of the headache. CONCLUSIONS: The widespread headache should be considered as the first symptom GCA and in cases of suspicion of vasculitis patients should have a full diagnostics examination. Colour duplex sonography and FDG-PET with total body contrast-enhanced CT are useful tools for non-invasive diagnosis of GCA.
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spelling pubmed-51495702016-12-19 Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica Manzo, Ciro Reumatologia Original Paper INTRODUCTION: In giant cell arteritis (GCA) headache of new onset due to inflammatory involvement of the temporal artery (TA) represents a diagnostic criterion. A widespread headache (WH) with scalp tenderness due to cranial arteritis can represent another manifestation of GCA. MATERIAL AND METHODS: In 225 elderly patients with polymyalgia rheumatica (PMR) followed in our rheumatologic outpatient clinic from 2004 until June 2016, the frequency of WH as the first clinical manifestation of GCA was evaluated. RESULTS: Among 26 patients with GCA+PMR (11.6% of total), 5 (23.07%) had WH as first clinical manifestation of GCA without TA. In all these patients TA colour duplex sonography (CDS) and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) with total body contrast-enhanced CT was consistent with the diagnosis of arteritis. TA biopsy was not performed. High doses of prednisone (1 mg/kg/day) led to the immediate and total disappearance of the headache. CONCLUSIONS: The widespread headache should be considered as the first symptom GCA and in cases of suspicion of vasculitis patients should have a full diagnostics examination. Colour duplex sonography and FDG-PET with total body contrast-enhanced CT are useful tools for non-invasive diagnosis of GCA. Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie 2016-11-28 2016 /pmc/articles/PMC5149570/ /pubmed/27994267 http://dx.doi.org/10.5114/reum.2016.63663 Text en Copyright: © 2016 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
spellingShingle Original Paper
Manzo, Ciro
Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica
title Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica
title_full Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica
title_fullStr Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica
title_full_unstemmed Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica
title_short Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica
title_sort widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149570/
https://www.ncbi.nlm.nih.gov/pubmed/27994267
http://dx.doi.org/10.5114/reum.2016.63663
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